8/8/2019 MPC Blank Application Form 2011
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Application Form For Marriage Preparation Course
*Please circle the intended date
18-19 June 2011 (Malay) / 22-23 Oct 2011 (Eng)*
Applicant's Information Partner's Information
Name (as in IC) Name (as in IC)
Gender Gender
Citizenship Citizenship
NRIC/FIN NRIC/FIN
Address Address
Postal Code Postal Code
Handphone No. Handphone No.
House phone No. House phone No.
Email Email
Race Race
Academic Achievment
Language Proficiency
Occupation Occupation
Income Income
Marital Status Marital Status
Islamic Knowledge Islamic Knowledge
Blood Type Blood Type
Mode of Payment
Mode of payment:
(Sat: 9:00 am to 1pm or 2-5 pm at Cyber Corner) (Sun: 9:00 am to
2 pm at Cyber Corner)
Registration
Course Fee
After which, registration will placed in the waiting list under
first come first served basis.
Participants Attendance
course. If absence in any part of the course, the Certificate of
Achievement will not be issued.
Assyakirin Mosque reserves the right to update the terms and
conditions from time to time as necessary.
Withdrawal and Refund The following conditions apply:
Additional Information
Please ensure that you are AT LEAST 21 years of age at the time
of registration.
If you are a divorcee, you should not have children below 12
years of age.
Date of Birth[DD/MM/YYYY]
Date of Birth[DD/MM/YYYY]
AcademicAchievement
Language Proficiency
j Cash /NETS at Reception/ Cyber Corner (Mon-Friday: 9:00 am to
5:00 pm at Reception Counter)
k Crossed cheque payable to LPM Assyakirin. Please indicate
marriage prep course, name and Hp no. at the back of chq.l Direct
Debit/ Internet Bank Transfer toOCBC Current A/C : 622-853976-001.
Please email reference no. and date of transfer
All registrations can be faxed to Assyakirin Mosque at: 6268
9725.
Alternatively, you may email the registration to
[email protected]
Course fee is SGD 130 per person, inclusive of educational
materials, certificate of completion & refreshments.
Confirmation of registration is subject to FULL PAYMENT of
course fee within 14 working days of registration.
Participants are required to meet 100% attendance. Certificate
of Achievement will be awarded to participants upon completion of
the
There will be NO Refund of Fees. Participants who wish to
withdraw from the curent intake will be transferred to the next
available intake in AssyakirinMosque. Should there be no available
intake, the full payment will be regarded as donation to the
mosque.
Maximum participants per course - 50 people.Course will only
commence when there are a minimum of 38 paid participants.
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